Mohammed T. Abou-Saleh

796 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYdisseminate to other staff members from other disciplines theknowledge they obtained during the team leadership training. Thisadaptation of the original model program was applied to thedevelopment of the Columbia University Geriatric PsychiatryResidency and Fellowship Programs, which are sponsored by theStroud Center and the Department of Psychiatry of the ColumbiaUniversity Faculty of Medicine, Binghamton Psychiatric Center ofthe New York State Office of Mental Health. This program isaccredited by the Accreditation Council for Graduate MedicalEducation. The Geriatric Psychiatry Residency and FellowshipPrograms bring together the clinical resources of the BinghamtonPsychiatric Center and the educational and clinical researchresources of the Stroud Center/Center for Geriatrics andGerontology of Columbia University.Since its inception, the Geriatric Psychiatry Residency andFellowship Programs has included, as a core ingredient of thelong-term care component of the curriculum 12 , the training ofpsychiatrist-fellows in the methods of interdisciplinary teamleadership. Additionally, every fellow is required, during his/herfellowship, to develop and/or lead an interdisciplinary treatmentteam under direct and regular supervision of fellowship faculty.PROGRAM DEVELOPMENTRationaleAll clinicians need a good system for identifying patients’symptoms, making informed treatment decisions regarding thepatients, and managing stress that is related to providing care. Allmembers of the treatment team need practical tools to guide themin eliciting, classifying, recording, and interpreting information onpatients’ health status and functioning—in short, a system thatwill help them to evaluate each patient’s status, identify theappropriate treatment, predict possible outcomes, and plan thepatient’s care. This system must also include methods to assistthe interdisciplinary team in functioning as a team and managingtheir own stress.A program designed to train interdisciplinary mental healthcare team members at psychiatric centers within the New YorkState Office of Mental Health was developed, implemented andevaluated 8,10 . The purpose of the program was to upgrade thefunctioning of the multidisciplinary/interdisciplinary mentalhealthcare treatment team and to train staff to identify andmanage the stress that developed as a result of caring for olderpsychiatric patients, many of whom are demented. The Programfor Organizing Interdisciplinary Self-education (POISE), thename by which the program is officially known, is a multidisciplinary/interdisciplinaryapproach to improving theassessment of patients in psychiatric hospitals and the treatmentplanning decisions based on those assessments. The program alsoprovides training of staff in current methods of stress management.POISE currently focuses on the training of the geriatricpsychiatrist as the central member of the interdisciplinary mentalhealthcare team.The geriatric psychiatrist is a key figure in the treatment andmanagement of geriatric patients in both inpatient and outpatientpsychiatric facilities. The geriatric psychiatrist is also a coremember of the interdisciplinary treatment team and is a key linkbetween service disciplines on the team in psychiatric settings.Regardless of the level of functioning of the team, the geriatricpsychiatrist is often viewed by team members as the primary carephysician who is ultimately responsible for leading the team andthus coordinating the treatment of geriatric patients. However,most geriatric psychiatrists receive little or no training that willenable them to work effectively as a core member of the interdisciplinaryteam and key link between team members.The geriatric psychiatrist and other members of the interdisciplinaryteam require special training to enable them to workeffectively together 13,16 . Training, which can be accomplishedeither formally or informally on and/or off the unit, can bedirected at facilitating and encouraging a team approach topatient care. This training must be durable in as much as it can bereplicated throughout an entire system of care to achieveobjectives; in that its effects last beyond the period of training;in that it concentrates on developing team cohesiveness andincreased productivity; and in as much as it is based on teachingthe team how to continue and maintain self-learning processes(including monitoring of own performance to achieve objectives).The training must be directed at a key member of the team (e.g.geriatric psychiatrist), who then goes on to train other members ofthe team. In this way, team functioning can continue, even in theabsence of the facilitator, the geriatric psychiatrist.The Columbia University Geriatric Psychiatry Residency andFellowship Programs includes training in interdisciplinary teamleadership as a core component of its training of geriatricpsychiatrists. This training component, POISE, is describedbelow. Details regarding the specific interdisciplinary treatmentteam training approaches used in the training of geriatricpsychiatrists are given in Toner et al. 14 and Miller and Toner 15 ,who have outlined the steps in developing and implementing ageriatric team.Program DescriptionPOISE is a durable, cost-effective approach to teaching geriatricpsychiatrists (i.e. residents and fellows in training) methods ofself-learning which serve as ongoing tools for planning treatmentfor patients. It is durable and cost-effective, in as much as thegeriatric psychiatrist, and ultimately other members of theinterdisciplinary team, learn methods of effectively working withone another by collaboratively setting goals and arriving atappropriate treatment decisions for the patient. After the geriatricpsychiatry resident/fellow receives core training in interdisciplinaryteam development and leadership, he/she is assigned to anexisting interdisciplinary team, where he/she imparts the coretraining to the members of the team. The team then continues toapply these methods on an ongoing basis and the geriatricpsychiatrist continues to provide guidance and leadership as thegroup leader/facilitator. This approach to staff training isuntraditional because, instead of relying on conventional didacticapproaches to learning or the charismatic qualities of the groupleader, the core training focuses on teaching the geriatricpsychiatrist the methods of self-learning in regard to assessment 16 .Geriatric assessment serves as the unifying theme of the training,because most staff conduct assessment in one way or another—including the nursing aides, who generally do not view themselvesas assessors—and because most staff feel they need additionaltraining in assessment. Furthermore, although most teammembers assess patient functioning, no single discipline considersassessment as their exclusive domain. In this way, while teammembers are organized and ultimately conditioned to focus on thetheme of assessment, interdisciplinary conflict revolving arounddisciplinary territorial issues is avoided, since no one discipline orindividual has exclusive rights to the theme. The theme ofassessment also serves as a springboard for discussing moregeneral group functioning issues.In POISE, the concept of self-learning is applied directly tothe training of the geriatric psychiatrist resident/fellow in along-term care setting serving the elderly. Thus, the geriatricpsychiatrist resident/fellow and other members of the interdisciplinaryteam are trained to develop their own skills andstrengths in regard to the identification, classification and